Literature DB >> 33717945

Routine postoperative blood tests in all patients undergoing Total Hip Arthroplasty as part of an enhanced recovery pathway: Are they necessary?

Vipul Garg1, Iain Byrom1, Neil Agnew1, Ian Starks1, Stephen Phillips1, Ibrahim A Malek1.   

Abstract

INTRODUCTION: The increasing demand for Total Hip replacement (THR)/Total Hip Arthroplasty (THA) continues to place significant financial pressure on the National Health Service (NHS). Many institutions undertake post-operative blood tests routinely in this group of patients. The aim of this study was to identify if such routine blood tests (Full Blood Count (FBC) and Urea and Electrolytes(U&Es)) are required in all THR patients post-operatively.
METHODS: Single institute, Multi-surgeon, retrospective observational study of consecutive patients who underwent primary elective THR done from Jan 2014 to Dec 2018.Post-operative blood tests and medical records were reviewed to identify derangement in haemoglobin (Hb) level and renal function requiring clinical intervention.
RESULTS: Over the period of 4 years, 353 patients underwent elective THR with mean age of 70 years (range: 42-90). There were 203 Males and 150 Females. Mean pre-operative Hb was 134.7 g/l. Mean post-operative drop in Hb was 22.3 g/l. None of the patients in ASA grade 1 and 2 with age ≤70 years required blood transfusion post operatively.6.4% of patients (n = 18/280) with an ASA of 1-2 had postoperative blood results requiring intervention of which only four (1.2%) were ≤70 years of age compared to 17.8% of patients (n = 14/73) with ASA 3-4.Overall none of the patients in ASA grade 1 and 2 with age ≤70 years required blood transfusion post operatively nor had electrolyte disturbance. 1.2% had deranged renal function that needed minor clinical intervention.
CONCLUSION: Routine post-operative blood analyses may not required for all patients undergoing THA. Young and healthier patients seldom have significant abnormalities on routine post-operative blood analyses which requires clinical intervention. Crown
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Entities:  

Keywords:  Blood analyses; Post-operative; Routine; THR; Total hip replacement; Transfusion

Year:  2021        PMID: 33717945      PMCID: PMC7920108          DOI: 10.1016/j.jcot.2021.01.003

Source DB:  PubMed          Journal:  J Clin Orthop Trauma        ISSN: 0976-5662


  10 in total

Review 1.  The operation of the century: total hip replacement.

Authors:  Ian D Learmonth; Claire Young; Cecil Rorabeck
Journal:  Lancet       Date:  2007-10-27       Impact factor: 79.321

2.  The Utility of Basic Metabolic Panel Tests After Total Joint Arthroplasty.

Authors:  Beau J Kildow; Vasili Karas; Elizabeth Howell; Cynthia L Green; William T Baumgartner; Colin T Penrose; Michael P Bolognesi; Thorsten M Seyler
Journal:  J Arthroplasty       Date:  2018-05-09       Impact factor: 4.757

Review 3.  Multimodal approach to control postoperative pathophysiology and rehabilitation.

Authors:  H Kehlet
Journal:  Br J Anaesth       Date:  1997-05       Impact factor: 9.166

4.  The potential for cost savings through bundled episode payments.

Authors:  David M Cutler; Kaushik Ghosh
Journal:  N Engl J Med       Date:  2012-03-22       Impact factor: 91.245

Review 5.  Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence.

Authors:  E M Soffin; J T YaDeau
Journal:  Br J Anaesth       Date:  2016-12       Impact factor: 9.166

6.  Routine Postoperative Laboratory Tests Are Not Necessary After Primary Total Hip Arthroplasty.

Authors:  Mohamad J Halawi; Julia M Plourde; Mark P Cote
Journal:  J Arthroplasty       Date:  2018-11-30       Impact factor: 4.757

7.  A comparison between the direct anterior and posterior approaches for total hip arthroplasty: the role of an 'Enhanced Recovery' pathway.

Authors:  I A Malek; G Royce; S U Bhatti; J P Whittaker; S P Phillips; I R B Wilson; J R Wootton; I Starks
Journal:  Bone Joint J       Date:  2016-06       Impact factor: 5.082

8.  Should postoperative haemoglobin and potassium levels be checked routinely following blood-conserving primary total joint arthroplasty?

Authors:  N J Greco; A G Manocchio; A V Lombardi; S L Gao; J Adams; K R Berend
Journal:  Bone Joint J       Date:  2019-01       Impact factor: 5.082

9.  When Should Complete Blood Count Tests Be Performed in Primary Total Hip Arthroplasty Patients?

Authors:  Beau J Kildow; Elizabeth P Howell; Vasili Karas; William T Baumgartner; Daniel J Cunningham; Cynthia L Green; Michael P Bolognesi; Thorsten M Seyler
Journal:  J Arthroplasty       Date:  2018-05-29       Impact factor: 4.757

10.  Reliability of the American Society of Anesthesiologists physical status scale in clinical practice.

Authors:  A Sankar; S R Johnson; W S Beattie; G Tait; D N Wijeysundera
Journal:  Br J Anaesth       Date:  2014-04-11       Impact factor: 9.166

  10 in total

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